80 Paediatric HIV

Phillipa Musoke 09/11/18

90% of childhood HIV infection are maternal transmission

90% kids in SSA

Half of Paeds HIV in 5 countries:

  • Nigeria
  • South Africa
  • Mozambique
  • India
  • Kenya

Mortality: 110,000 children die of HIV related deaths annually (down 45% since 2010)

Mortality is higher in kids infected perinatally versus those infected postnatally.

Mortality is 10x higher for children infected with HIV versus those who aren’t

Malnutrition: Most HIV infected children are malnourished. Up to 15% of kids hospitalised with SAM are HIV+

HIV with SAM is 4x Higher Mortality than just SAM

Causes of deaths in kids with HIV, much that same of deaths in kids without HIV (Diarrhoea, Pneumonia, Fever, Anaemia, Malaria - not necessarilly in that order)

HIV negative kids born to HIV positive mothers are more likely to die (4x increase in risk), but if the mum is on ART that risk is gone.

Why do kids with HIV get sick? Malnutrition, Pneumonia, Malaria, Gastroenteritis. So same as kids without HIV, but more often and more severe!

Co trimoxazole prophylyaxis for kids with HIV protects against malaria

Somewhere between 6-40% of HIV infected kids have neurodevelopmental delay. Also with stunting. These things are reduced risk with early ART intitiation.

What are the WHO AIDS Free Target Strategy for Children?

  • Start Free - reduce new infections in kids, get ARTs to pregnant women
  • Stay Free - reduce new infections in adoselscents, male circumsicion
  • AIDS Free - improve access to ARTs for adolescents with HIV

80.1 Eliminating Mother To Child Transmission

Exclusive BF reduces risk of HIV transmission when compared to mixed feed. Mixed feed irritates and inflames the gut, causing increased risk of HIV transmission.

Prolonged breastfeeding in 2nd year accounts for up to half of all MTCT of HIV

High maternal VL and Mastitis will increase risk of MTCT

When mother not on ART:

In utero = 20% of MTCT

Labor and delivery = 40-50% of MTCT

BF = 40% of MTCT

When mother on ART, risk of in utero MTCT goes way down, so relatively BF risk goes up.

(Single dose nevirapine (one dose to mum, one dose to baby) reduces risk of MTCT by about 40% (when compared to AZT). But the PROMISE study now shouls that starting the mum on triple therapy is more effective than AZT + Nevirapine. The problem with triple therapy may cause the babies to be born premature, with low birth weight.)

WHO now states: All pregnant and breastfeeding women should be on ART (Tenofovir/Lamivudine/Efavirenz), HIV+ mums breastfeed for 12 months at least.

Current guidleines for HIV exposed infants: Babies should get tested at 4 to 6 weeks (with a dried blood spot). Babies should get nevirapine prophylaxis at birth until 6 to 12 weeks. (if mum is positive and diagnosed at childbirth, sometimes just give triple therapy to baby for 12 weeks till testing). Cotrimoxazole prophylaxis should be given from one month. Vaccinate as usually. Final HIV test for infant at 18 months.

When do you test the baby after the mum stops breastfeeding? Wait 6 weeks then test

There is a push from WHO to do testing at birth. This has been taken up by some countries but is more expensive.